A mixed methods analysis of the medication review intervention centered around the use of the 'Systematic Tool to Reduce Inappropriate Prescribing' Assistant (STRIPA) in Swiss primary care practices

Background: Electronic clinical decision support systems (eCDSS), such as the ‘Systematic Tool to Reduce Inappropriate Prescribing’ Assistant (STRIPA), have become promising tools for assisting general practitioners (GPs) with conducting medication reviews in older adults. Little is known about how GPs perceive eCDSS-assisted recommendations for pharmacotherapy optimization. The aim of this study was to explore the implementation of a medication review intervention centered around STRIPA in the ‘Optimising PharmacoTherapy In the multimorbid elderly in primary CAre’ (OPTICA) trial. Methods: We used an explanatory mixed methods design combining quantitative and qualitative data. First, quantitative data about the acceptance and implementation of eCDSS-generated recommendations from GPs (n = 21) and their patients (n = 160) in the OPTICA intervention group were collected. Then, semi-structured qualitative interviews were conducted with GPs from the OPTICA intervention group (n = 8), and interview data were analyzed through thematic analysis. Results: In quantitative findings, GPs reported averages of 13 min spent per patient preparing the eCDSS, 10 min performing medication reviews, and 5 min discussing prescribing recommendations with patients. On average, out of the mean generated 3.7 recommendations (SD=1.8). One recommendation to stop or start a medication was reported to be implemented per patient in the intervention group (SD=1.2). Overall, GPs found the STRIPA useful and acceptable. They particularly appreciated its ability to generate recommendations based on large amounts of patient information. During qualitative interviews, GPs reported the main reasons for limited implementation of STRIPA were related to problems with data sourcing (e.g., incomplete data imports), preparation of the eCDSS (e.g., time expenditure for updating and adapting information), its functionality (e.g., technical problems downloading PDF recommendation reports), and appropriateness of recommendations. Conclusions: Qualitative findings help explain the relatively low implementation of recommendations demonstrated by quantitative findings, but also show GPs’ overall acceptance of STRIPA. Our results provide crucial insights for adapting STRIPA to make it more suitable for regular use in future primary care settings (e.g., necessity to improve data imports). Trial registration: Clinicaltrials.gov NCT03724539, date of first registration: 29/10/2018

CT-guided infiltration saves surgical intervention and fastens return to work compared to anatomical landmark-guided infiltration in patients with lumbosciatica

BACKGROUND Infiltration procedures are a common treatment of lumbar radiculopathy. There is a wide variety of infiltration techniques without an established gold standard. Therefore, we compared the effectiveness of CT-guided transforaminal infiltrations versus anatomical landmark-guided transforaminal infiltrations at the lower lumbar spine in case of acute sciatica at L3-L5. METHODS A retrospective chart review was conducted of 107 outpatients treated between 2009 and 2011. All patients were diagnosed with lumbar radiculopathic pain secondary to disc herniation in L3-L5. A total of 52 patients received CT-guided transforaminal infiltrations; 55 patients received non-imaging-guided nerve root infiltrations. The therapeutic success was evaluated regarding number of physician contacts, duration of treatment, type of analgesics used and loss of work days. Defined endpoint was surgery at the lower lumbar spine. RESULTS In the CT group, patients needed significantly less oral analgesics (p < 0.001). Overall treatment duration and physician contacts were significantly lower in the CT group (p < 0.001 and 0.002) either. In the CT group, patients lost significant fewer work days due to incapacity (p < 0.001). Surgery had to be performed in 18.2 % of the non-imaging group patients (CT group: 1.9 %; p = 0.008). CONCLUSION This study shows that CT-guided periradicular infiltration in lumbosciatica caused by intervertebral disc herniation is significantly superior to non-imaging, anatomical landmark-guided infiltration, regarding the parameters investigated. The high number of treatment failures in the non-imaging group underlines the inferiority of this treatment concept

Possibilities of Efficiency Improvement at Creative Industries Companies of Latvia

Radošās industrijas ir viens no visstraujāk augošajiem ekonomikas sektoriem mūsdienās, tādēļ, lai veicinātu Latvijas radošo nozaru konkurētspēju, uzņēmumiem nepieciešams pastāvīgi pilnveidot savas darbības efektivitāti. Maģistra darba mērķis ir izstrādāt radošo industriju uzņēmumu efektivitātes pilnveidošanas metodes un paņēmienus to praktiskai izmantošanai. Darbā apkopotas teorētiskās atziņas par radošo industriju nozīmi, to efektivitātes pilnveidošanas metodēm, vispārīgi raksturotas Latvijas radošās industrijas, kā arī tika veikts pētījums par radošo industriju uzņēmumu radošuma un efektivitātes vadību, un, pamatojoties uz rezultātiem, autore izstrādāja modeli, veica secinājumus un priekšlikumus radošo industriju veiktspējas uzlabošanai. Darba apjoms: 98 lpp., attēlu skaits - 24, tabulu skaits - 4, pielikumu skaits - 8.Creative industries are now one of the most developing sectors of global economy, therefore, to further competitiveness of creative industries of Latvia, companies have to constantly improve their operational efficiency. The objective of the Master’s Thesis is to develop efficiency improvement techniques for practical use of creative industries companies. In the Thesis the theory aspects of creative industries essence, their efficiency improvement methods are described, the creative industries of Latvia are characterized. A study of creative industries business creativity and efficiency management was performed, and on this basis, the author developed a model, made conclusions and proposals for creative industries performance enhancement. The Thesis is written on 98 pages, number of images is 24, number of tables - 4, number of annexes - 8